Transcript General Psychology

Mental Disorders
© Kip Smith, 2003
Topics
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Categories of mental disorders
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Neuroses
Psychoses
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Neuroses
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Psychoses
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Diagnosis using the DSM
© Kip Smith, 2003
Mental distress ≠
mental disorder
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Just because you are bummed out doesn’t
mean you are mentally ill
For example, sadness, pessimism and low
self-esteem are all parts of normal mental
life, as long as they
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Do not persist
Do not have a biological origin
Are essentially voluntary
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© Kip Smith, 2003
E.g., you know WHY you are temporarily bummed
Mental disorders
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Neurosis
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Distressed but still rational and social
Psychosis
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Loss of contact with reality, irrational ideas &
distorted perception
© Kip Smith, 2003
Criteria for considering behavior
to be a Disorder
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The behavior must be
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Unjustifiable &
Maladaptive &
Atypical &
Disturbing ==
Distressing
© Kip Smith, 2003
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Distressing behavior
may be rational or not
If behavior is NOT in
the person’s best
interest, then the
behavior suggests
some form of
psychosis
Rationality
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Acting in a manner that you know
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is in your own best interest =
will help you achieve your goal
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Neurotics are rational but distressed
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Psychotics are NOT rational
© Kip Smith, 2003
Examples of Neuroses
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Anorexia - bulimia
Anxiety
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Mood disorders
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Depression
Mania
Bipolar syndrome
Personality disorders
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Obsessive - compulsive
Post trauma stress
Phobia
Anti-social
Histrionia
Narcissism
Sexual dysfunction
Substance abuse
© Kip Smith, 2003
Sometimes it is hard to
tell when a behavior
crosses the line
from neurosis
to psychosis
Anorexia - bulimia
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Anorexia nervosa is a life-threatening eating disorder
defined by a refusal to maintain body weight within 15 %
of an individual's minimal normal weight. Other essential
features of this disorder include an intense fear of gaining
weight, a distorted body image, and amenorrhea (absence
of at least three consecutive menstrual cycles when
otherwise expected to occur) in women. Sometimes people
starve and binge-purge, depending on the extent of weight
loss. This can be physically very dangerous. People who
present an on-going preoccupation with food and weight
even at lesser weight reductions would benefit from
exploring their cognitive and relationship skills.
http://www.nami.org/helpline/anorexia.htm
© Kip Smith, 2003
If you know someone with anorexia Force her to confront it
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http://www.anred.com
© Kip Smith, 2003
http://www.altrue.net/
site/anadweb/
Anxiety (Neurosis)
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Continually tense,
apprehensive;
persistent autonomic
(sympathetic) arousal
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Obsessive-compulsive
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Phobia
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© Kip Smith, 2003
Anxiety with unwanted
repetitive thoughts
and/or actions
High need for perfection
and order
Persistent irrational fear
Panic
Post-traumatic stress
Obsession
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Recurrent and persistent thoughts, impulses, or images
that are experienced, at some time during the disturbance,
as intrusive and inappropriate and that cause marked
anxiety or distress
The thoughts, impulses, or images are not simply excessive
worries about real-life problems
The person attempts to ignore or suppress the thoughts,
impulses, or images, or to neutralize them with some other
thought or action
The person recognizes that the obsessional thoughts,
impulses, or images are a product of his or her own mind
(not imposed from without as in thought insertion)
© Kip Smith, 2003
Compulsion
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Repetitive behaviors (e.g., hand washing, ordering,
checking) or mental acts (e.g., praying, counting, repeating
words silently) that the person feels driven to perform in
response to an obsession, or according to rules that must
be applied rigidly
The behaviors or mental acts are aimed at preventing or
reducing distress or preventing some dreaded event or
situation; however, these behaviors or mental acts either
are not connected in a realistic way with what they are
designed to neutralize or prevent or are clearly excessive
http://www.narsad.org/bd/ocp.html
© Kip Smith, 2003
Obsessive-Compulsive disorder
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At some point during the course of the disorder, the person
has recognized that the obsessions or compulsions are
excessive or unreasonable.
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Note: This does not apply to children.
The obsessions or compulsions cause marked distress, are
time consuming (take more than one hour a day), or
significantly interfere with the person's normal routine,
occupational (or academic) functioning, or usual social
activities or relationships.
Reprinted from the Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition. Copyright 1994 American
Psychiatric Association.
© Kip Smith, 2003
Mood Disorders (Neurosis)
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Depression, Feelings
of:
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worthlessness
low self-esteem
pessimism
low motivation
generalization of
negative attitudes
psychomotor dysfunction
More women than men
(report) being depressed
2: 1
© Kip Smith, 2003
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Mania
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Euphoria
Inflated self-esteem
Grandiosity
Fragmented attention
Bipolar
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Mood swings between
the hopelessness of
depression and the
euphoria of mania
(manic depression)
Depression
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http://www.narsad.org/bd/dep.html
Depression isn't just a brief blue mood or
a passing sadness that lifts in a few hours
or even a few days. People who have
depression -- or, in more formal clinical
terms, major depressive disorder -experience at least five of the following
symptoms, which must include the first or
second, nearly every day, all day, for at
least two weeks:
© Kip Smith, 2003
Symptoms of depression, 1
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Persistent depressed mood, including feelings of sadness or
emptiness
Loss of interest or pleasure in activities or hobbies that
were once enjoyed, including sex
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Feelings of hopelessness and pessimism
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Feelings of guilt, worthlessness, and helplessness
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Insomnia, early-morning awakening, or oversleeping
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Loss of appetite accompanied by weight loss or overeating
accompanied by weight gain
© Kip Smith, 2003
Symptoms of depression, 2
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Decreased energy, fatigue, and feeling "slowed down"
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Restlessness and irritability
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Difficulty concentrating, remembering, and making
decisions
Thoughts of suicide or death (not just fear of dying) or
suicide attempts
Persistent physical symptoms, such as headaches,
digestive disorders, or chronic pain, that do not respond to
medical treatment and for which no physical cause can be
found
© Kip Smith, 2003
Mania
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A manic episode is characterized by a
distinct period of a mood change that is
either elevated (to the point of elation),
expansive, or irritable.
During this phase, which may last from
several days through several months, the
patient's behavior causes difficulties in
both professional and social activities.
http://www.narsad.org/bd/bip.html
© Kip Smith, 2003
Symptoms of mania
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Decreased need for sleep
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Increased pressure of speech
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Distractibility
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Irritability
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Inflated self-esteem or grandiosity
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Excessive involvement in activities that have a high risk for
pain consequences that are not recognized
© Kip Smith, 2003
Bipolar syndrome
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Behavior oscillates between depression
and mania
Used to be called manic depression
© Kip Smith, 2003
Bipolar manic episodes
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Frequently, those experiencing a manic episode
do not realize they are affected and will therefore
resist any medical treatment attempt.
Close friends will recognize the mood and
behavior patterns as being excessive, while the
casual observer may not see anything disturbing.
The patient may become frankly psychotic with
delusions and hallucinations.
© Kip Smith, 2003
Bipolar depressed episodes
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A depressive phase usually lasts two weeks to
many months, during which the time the patient
will experience a lack of interest or pleasure in all
activities.
Patients may describe themselves as feeling sad
or blue, devoid of motivation, or worthless.
These feelings and thoughts may or may not be
stated openly in front of others.
© Kip Smith, 2003
Bipolar depressed episodes
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The course of a depressive episode may vary
from person to person. Symptoms may develop
over a period of days or weeks, or they may
occur suddenly, without warning. Sudden onset
of this condition can be caused by external
factors, including stress, death of a family
member, or divorce. Duration of an episode will
vary and depends on medical treatment
employed.
http://www.narsad.org/bd/bip.htm
© Kip Smith, 2003
Personality Disorders (Neurosis)
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Inflexible and enduring
patterns of behavior
that impair social
functioning
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Relatively untreatable
Patients do not think
anything is wrong &
resist treatment
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Histrionic
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Narcissistic
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Exaggerated self-image
(aided by fantasies)
Anti-Social
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© Kip Smith, 2003
Display shallow,
attention-getting
emotions, sexual
aggression
Complete disregard for
others’ rights
Lack of a conscience for
wrong-doing
Psychosis
Alzheimer’s
Schizophrenia
Dissociation
Amnesia
Fugue
Identity disorder
© Kip Smith, 2003
Poster Boy for Psychosis
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Ted Kaczynski,
exprofessor of math,
lived alone in a shack,
rarely bathed, sent
bombs to strangers
© Kip Smith, 2003
Schizophrenia
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Schizophrenia is classified in people who
exhibit the following traits:
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Characteristic symptoms
Social/occupational dysfunction
Duration > 6 months
No mood disorders (depression, mania, mixed)
Not due to drug use
Not due to developmental disorder (autism)
© Kip Smith, 2003
Symptoms of schizophrenia
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Two (or more) of the following, each present for a
significant portion of time during a 1-month period (or less
if successfully treated):
1. delusions
2. hallucinations
3. disorganized speech (e.g., frequent derailment or
incoherence)
4
grossly disorganized or catatonic behavior
5. negative symptoms, i.e., affective flattening, alogia, or
avolition
© Kip Smith, 2003
Positive and negative symptoms
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Positive symptoms
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Disorganized, delusional
thinking
Distorted perception,
Inappropriate emotions
and actions
Bizarre behavior
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± Paranoia
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Pervasive distrust and
suspicion of others
± Catatonia
© Kip Smith, 2003
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Negative symptoms
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No interest in other
people or social
relationships
Detached from social
relationships
Emotionally cold with flat
affect
Pervasive interpersonal
deficits
Poverty of speech
Apathetic attention
Social dysfunction
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For a significant portion of time since the onset
of the disturbance, one or more major areas of
functioning such as work, interpersonal relations,
or self-care are markedly below the level
achieved prior to the onset (or when the onset is
in childhood or adolescence, failure to achieve
expected level of interpersonal, academic, or
occupational achievement).
http://www.narsad.org/bd/sch.html
© Kip Smith, 2003
Psychopharmacology of
Schizophrenia
Too much dopamine in
the frontal lobe
The mind runs amok
© Kip Smith, 2003
Dissociative Disorders
(Psychoses)
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A disruption in the
usually integrated
functions of
consciousness,
memory, identity or
perception
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Amnesia
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Fugue
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Fail to recall past &
Run away &
Assume new identity
Identity Disorder
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© Kip Smith, 2003
Fail to recall events
Multiple personalities
Most rare, usually faked
Diagnosing neuroses and
psychoses
© Kip Smith, 2003
Diagnostic and Statistical Manual
of Mental Disorders
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DSM 4th edition
Provides a multidimensional approach to
diagnosing disorders
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diagnostic criteria
prevalence data
case illustrations
Uses decision trees to guide diagnoses
© Kip Smith, 2003
DSM’s 5 Dimensions of Disorder
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1
2
3
4
5
Clinical symptoms
Personality disorders
General medical conditions
Psychosocial & environmental problems
Global assessment of functioning
The dimensions are NOT mutually exclusive
© Kip Smith, 2003
1 Clinical symptoms
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Anxiety
Depression
Schizophrenia
Substance abuse
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Includes alcohol
© Kip Smith, 2003
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Disorders
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Sleep
Sexual
Eating
2 Personality Disorders
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Obsessive-compulsive
Dependent personality
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Passively allows others to make decisions
Antisocial personality
© Kip Smith, 2003
3 General Medical Conditions
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Any medical conditions relevant to
understanding or treatment
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Organic brain damage
Diabetes
HIV
© Kip Smith, 2003
4 Psychosocial, Environmental
Problems
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Social support structure
Death of a loved one
Discrimination
Economic or legal problems
© Kip Smith, 2003
5 Global Assessment of
Functioning
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Current occupational functioning
Highest level of functioning in the past
year
© Kip Smith, 2003
Sample DSM Decision Tree for a
Patient with Depressed Mood
If YES
If
NO
Due to a medical condition
Mood disorder due to a med. cond.
Due to drug, meds, or toxins
Substance-induced mood disorder
Periods of mania
and at least one
period of depression
Bipolar disorder, Type 1
Periods of mild mania and
mild depression
Bipolar disorder, Type 2
Periods of depression with
psychosis
(delusions or hallucinations)
when not depressed
Schizophrenia
© Kip Smith, 2003
Depression
Models of Psychological Disorders
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Medical model
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Diathesis-Stress Model
Disorders are diseases
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Disorders can be
diagnosed on the basis
of their symptoms
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Disorders can be treated
and, often, cured
© Kip Smith, 2003
Biological predisposition
+ Stress -> disorder
“Humpty dumpty had a
thin shell.
Didn’t break until he
fell.”